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NPSA issues nasogastric flushing warning

The National Patient Safety Agency has repeated a warning on the risk of harm posed by flushing nasogastric tubes before confirmation of placement.

The rapid response report said nothing should be introduced down the tube before gastric placement has been confirmed; nurses must not flush the tube before gastric placement has been confirmed; and internal guidewires or stylets should not be lubricated before placement confirmation. 

It follows a patient safety alert issued by the NPSA in March 2011 about reducing harm caused by misplaced nasogastric tubes. It required trusts to ensure tubes were not flushed nor liquid introduced until the tube tip was confirmed to be in the stomach by pH testing or x-ray.

However, the NPSA said it was aware of three incidents, two of which resulted in death, since the alert went out where staff had flushed tubes with water before initial placement was confirmed.

It said: “The three organisations where the incidents occurred were aware of the NPSA alert but there appeared to be a widespread belief among their frontline staff that the ‘never flush’ rule did not apply where nasogastric tubes had a water-activated lubricant. This belief is incorrect.”

 

Readers' comments (6)

  • if you have a lubricant which is water activated to help get the tube down then how do you activate it without using water,
    do you just tip the end in a pot of water. I've never heard of it.

    I would never flush a ng tube, I can't imagine why anyone would. Either we aspirate stomach contents or get an xray done. 20 years ago we used to blow air into the tube and listen for stomach noises but we don't do that anymore.

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  • isn't this common sense?

    the goal surely isn't to kill patients by running the risk of pushing air into the lungs!

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  • from Anonymous | 14-Apr-2012 9:23 above

    'sorry obviously should have been written

    pushing fluid into the lungs!'

    still no signs of an edit before submitting facility on this site.

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  • Why not use a water based lubricant, instead of a water activated one? In anyway, humidyt from the inside of superior airways, pharynx and esophagus, should be more than enough to activate water activated lubricants, or am i wrong?

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  • I am confused, were the tubes flushed to make sure they worked properly before being placed or were they flushed once inside someones tummy (hopefully).

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  • if the end of the tube is put in a glass of water and it bubbles you know you are in the lungs and not in the stomach.If you inject a small amount of air in quickly and there is a hollow sound you are in the stomach. If you aspirate a small amount of gastric contents, idem. However, you do not flush out the tube, prior to giving feed until these tests have been carried out. The tube must be flushed out with water after each feed to prevent blockage, which is often overlooked, and it needs to be gently mobilised with a small twisting action periodically to prevent it sticking to the delicate gastric mucosa and causing necrosis, also frequently overlooked. Sips of water can be given to the patient to swallow to facilitate passage of the tube.

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